Deep vein thrombosis and changes in coagulation and fibrinolysis after gynaecological operations in Chinese: The effect of oral contraceptives and malignant disease

Abstract

Of 154 Chinese patients who underwent gynaecological operations, four showed a positive 125I fibrinogen leg scan for venous thrombosis, an overall incidence of 2.6%. In those who were on oral contraceptives and had major pelvic surgery for benign conditions, the incidence was 10.5%; in those who had Wertheim hysterectomy for carcinoma of cervix, it was 6.7%. This confirms the rarity of post-operative thromboembolism in the Chinese. Fragment E showed a biphasic rise after major operation due to tisue injury and venous thrombosis. In patients with malignancy, the postoperative 'fibrinolytic shutdown', represented by decreased plasminogen activator together with increased α 1 antitrypsin and C - 1 inhibitor levels, was more marked. In addition, α 2 macroglobulin level was lower and fell significantly after operation. In patients on oral contraceptives, fragment E levels were higher after surgery and there was no decrease in plasminogen activator levels. Antithrombin III levels did not fall except in three of the four patients with venous thrombosis. A marked increase in fragment E level and a decrease in antithrombin III level might be useful diagnostic markers for postoperative venous thrombosis. | Of 154 Chinese patients who underwent gynecological operations, 4 showed a positive fibrinogen leg scan for venous thrombosis, an overall incidence of 2.6%. In those who were on (OC) oral contraceptives and had major pelvic surgery for benign conditions, the incidence was 10.5%; in those who had Wertheim hysterectomy for carcinoma for cervix, it was 6.7%. This confirms the rarity of postoperative thromboembolism in the Chinese. Fragment E showed a biphasic rise after major operation due to tissue injury and venous thrombosis. In patients with malignancy, the postoperative fibrinolytic shutdown, represented by decreased plasminogen activator together with increased alpha 1 antitrypsin and C inhibitor levels, was more marked. In addition alpha 2 macroglobulin level was lower and fell significantly after operation. In patients on OCs, fragment E levels were higher after surgery and there was no decrease in plasminogen activator levels. Antithrombin 3 levels did not fall except in 3 of the 4 patients with venous thrombosis. A marked increase in fragment E level and a decrease in antithrombin 3 level might be useful diagnostic markers for postoperative venous thrombosis.